Pickwickian Syndrome

Pickwickian syndrome is also known as obesity hypoventilation syndrome.

Pickwickian syndrome is a complex of respiratory and circulatory symptoms associated with some cases of extreme obesity.

The major health problem that occurs in patients with this disease is sleep apnea.

The conditions often related with obstructive sleep apnea include obesity and a short thick neck, and reduction in muscle tone of the soft palate, the uvula (the small, conical, fleshy tissue hanging from the center of the soft palate), and the pharynx.

The upper airway may be narrowed by enlarged tonsils or adenoids, nasal polyps, a deviated nasal septum, or congenital abnormalities. Even at high altitudes sleep disruption may take place because of low oxygen concentration.

Causes and symptoms:

The Pickwickian syndrome is caused due to extreme obesity. This obesity puts an excessive load on the pulmonary system. Pickwickian syndrome symptoms include shortness of breath due to elevated blood carbon dioxide pressure, disturbed sleep at night, excessive daytime sleepiness, and flushed face. The skin can also have a bluish hue, and the patient may have high blood pressure, an enlarged liver, and an abnormally high red blood cell count.

Pickwickian Syndrome Diagnosis:

Tests that can be used to diagnose this condition include echocardiography which is used to determine heart enlargement or pulmonary hypertension. Multiple sleep latency tests should be given which can help give an objective measurement of daytime sleepiness. Magnetic resonance imaging (MRI), fiber optic evaluation of the upper airway, or computed tomography (CT) scans may also be used.

Pickwickian Syndrome Treatment

The primary Pickwickian syndrome treatment is focused on weight loss which reduces episodes of sleep apnea and improves the blood gases and physical activity. Also, medroxyprogesterone may help improve the condition. Nocturnal positive pressure air flow can be dramatically efficient. A few patients requires an opening in the windpipe (tracheotomy).

Prognosis:

Pickwickian syndrome is totally reversible if it is diagnosed and treated properly. If the problem goes undiagnosed, the outcome can be serious.

Prevention:

Prevention of Pickwickian syndrome can be attained by maintaining a healthy body weight and getting the proper amount of exercise. For prevention of the sleep apnea that usually accompanies Pickwickian syndrome, there are several possible treatments. If the sleep apnea is only present when the patient is flat on their back, a tennis ball can be sewn into the sleep clothes to remind the patient not to sleep on their back. For more severe cases of sleep apnea, a tonsillectomy or the use of dental appliances may be suggested.